College Lakes

LBN: College Lakes
College Lakes is an health care organization with primary practice located at 5104 Flatrock Drive , Fayetteville NC 28311. The organization recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as the primary health care specialty. College Lakes can be contacted via phone (910) 488-6323, or through Creecy, Nikki Giovanni via phone (910) 257-6406.

Contact Information

Primary practice address
5104 Flatrock Drive Fayetteville NC 28311
Phone: (910) 488-6323
Fax: (910) 223-2180
Website:
Map and Directions
Authorized official contact:
Name: Creecy, Nikki Giovanni
Phone: (910) 257-6406

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X MHL-047-133 North Carolina

Profile Details

NPI number 1841612215
LBN Legal business name College Lakes
DBA Doing business as
Authorized official Creecy, Nikki Giovanni
Entity Organization
Organization subpart 1 Yes
Enumeration date Jan 20th, 2014
Last updated Apr 21st, 2021 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841612215 NPPES
North Carolina MEDICAID 3418071

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